Cass J R, Morrey B F, Katoh Y, Chao E Y
Clin Orthop Relat Res. 1985 Sep(198):110-7.
Twenty-five consecutive primary ligament repairs and 40 delayed reconstructions for lateral collateral ankle ligament injuries were studied. Response to a questionnaire provided a 94% subjective evaluation at a mean of 9.5 years after surgery; 97% of patients were satisfied with the surgical result. Clinical examination, stress radiography, and biomechanical gait analysis studies were performed on 39 patients at four years or more after surgery (mean, 9.6 years). In 14% of those with ligament repair and 41% of those with reconstructive procedures, mean residual talar tilt with stress testing was 3.2 degrees and 5.2 degrees, respectively. Gait studies did not demonstrate a consistent abnormal gait pattern, even with side slope walking, and did not correlate with the talar tilt values. There was no significant measurable difference between the results of repair and reconstruction. Thus, most severe Grade III sprains can be managed nonoperatively, and if late residual instability occurs, a reconstructive procedure can be offered with confidence that the result will be equivalent subjectively and roughly comparable objectively to that of the immediate repair.
对25例连续性外侧副韧带损伤的一期韧带修复及40例延期重建进行了研究。术后平均9.5年时，问卷调查的主观评价应答率为94%；97%的患者对手术结果满意。在术后4年或更长时间（平均9.6年），对39例患者进行了临床检查、应力位X线摄影及生物力学步态分析研究。在韧带修复患者中，14%的患者应力试验时距骨平均残留倾斜度为3.2°；在重建手术患者中，41%的患者应力试验时距骨平均残留倾斜度为5.2°。步态研究未显示出一致的异常步态模式，即使在侧坡行走时也是如此，且与距骨倾斜度值无相关性。修复与重建结果之间无显著的可测量差异。因此，大多数严重的Ⅲ度扭伤可采用非手术治疗，若后期出现残留不稳定，可进行重建手术，且可确信其主观结果与一期修复相当，客观结果大致可比。
